[Ruptured renal tumor as a rare differential diagnosis of colicky abdominal pain].
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Aged↗
Biomedical subjects
T Pottek
Publications and source records attributed to T Pottek.
Single agent carboplatin for CS IIA/B testicular seminoma. A phase II study of the German Testicular Cancer Study Group (GTCSG).
BACKGROUND: The aim was to investigate the use of single agent carboplatin in patients with seminoma stage IIA/B. PATIENTS AND METHODS: In a prospective phase II trial, single agent carboplatin at a dose of AUC 7 mg.min/ml every 4 weeks for three cycles in stage IIA (n=51) or four cycles in stage IIB (n=57) was given to 108 patients with previously untreated seminoma stage IIA/B. Patients with residual masses of >or=3 cm were scheduled to receive secondary surgery. RESULTS: A complete response (CR) was achieved by 88/108 (81%) patients, 17/108 (16%) achieved a partial response (PR), two of 108 (2%) showed no change, and one patient progressed. In all patients with PR the residual disease was <or=3 cm; yet in two of 17 patients with PR, in two of two patients with NC and in one patient with disease progression residual tumor resection was performed demonstrating vital seminoma. Toxicity was acceptable with grades 3 and 4 myelosuppression, nausea and vomiting in less than 10% of patients each. After a median follow-up of 28 months (range 1-68 months) 14/108 (13%) patients relapsed, all after having achieved a CR. All relapses occurred in the retroperitoneum. One patient died from an unrelated cause. The overall failure rate was 19/108 patients (18%). The overall and disease specific survival was 99% and 100%, respectively. CONCLUSIONS: Four cycles of single agent carboplatin AUC 7 do not safely eradicate retroperitoneal metastases in patients with stage IIA/B seminoma.
Adult↗
Gene expression profiling in seminoma and nonseminoma.
PURPOSE: Gene expression profiles of seminoma were compared with nonseminoma to get insights into tumorigenesis. MATERIALS AND METHODS: Eleven testicular tumor biopsies (five pure seminoma, six nonseminoma; pT1N0M0 to pT2N2M1) and biopsies from unaffected sites were analyzed once per patient using a macroarray (1,176 genes). On the same patients, six genes were validated using real-time quantitative (RTQ) polymerase chain reaction (PCR). Additionally, in a separate cohort of 19 patients, 24 genes selected from the macroarray were measured using RTQ-PCR. RESULTS: (1) The agreement in gene expression was 94% between the two methods and two different patient cohorts. (2) Two features in gene expression were independent of the tumor entity: Most changes of gene expression occurred in five functional groups like "cell cycle" and "apoptosis." Genes within these groups were almost similarly (> 80%) up- or downregulated. (3) Nonseminoma were characterized by downregulated genes (75%), but in seminoma, upregulated genes (64%) prevailed. Furthermore, 64.4% of those genes that were differentially expressed in both tumor entities were usually upregulated in seminoma but downregulated in nonseminoma. A reverse pattern was found in 24.4% of such genes. Eleven percent of these genes showed a similar up- or downregulation in gene expression in both tumor entities. CONCLUSION: Seminoma in this preliminary study can be differentiated from nonseminoma due to almost opposing gene expression profiles (89% of the significantly differentially expressed genes) and are in line with the histological discrimination of both tumor entities. Underlying mechanisms and implications regarding the origin and tumor progression of both entities are discussed.
Adolescent↗
[Urinary retention with ruptured fornix caused by a maggot. An autoerotic accident].
Foreign bodies in the urinary tract represent a possible cause for genitourinary disease. A huge variety of objects are inserted into the urinary tract for therapeutic, autoerotic, or psychiatric reasons and the symptoms for foreign bodies can be rather unspecific. Dysuria, hematuria, and urinary tract infection can suggest the presence of intravesical foreign bodies. Symptomatic urinary retention is more seldom and the causal foreign bodies are mostly iatrogenically applied. We present a unique case of maggots self-inserted into the urinary tract for autoerotic reasons causing symptomatic urinary retention with fornix rupture.
Accidents↗
Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer.
PURPOSE: To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT). PATIENTS AND METHODS: Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment. RESULTS: Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis. CONCLUSION: Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.
Antineoplastic Combined Chemotherapy Protocols↗
[Retroperitoneal lymph node dissection in testis cancer].
According to the rules of the European Interdisciplinary Consensus, retroperitoneal lymph node dissection (RPLND) will be indicated less frequently in patients with nonseminomatous testis cancer. In clinical stage I it will be done only exceptionally and in stage II A only in marker-negative patients. In all other stages RPLND will be recommended as residual tumor resection and additionally in "growing teratoma syndrome" and in rare situations as "desperation surgery." It will be difficult in future using the minor operations to enter the learning curve. Only advanced situations will have to be managed by urological surgeons. These operations will have to be performed predominantly in specialised centres.
European Union↗
European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG).
Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.
Europe↗
Angiogenic switch and vascular stability in human Leydig cell tumours.
The high degree of vascularisation, accompanied by the low malignancy of human Leydig cell tumours, offers an interesting model to study the neovascularisation and structural stabilisation of the vascular wall. We report here that Leydig cell tumours are characterised by an increased level of vascular endothelial growth factor (VEGF) in testicular veins, the presence of VEGF mRNA and of its receptor, KDR, and an absence of detectable VEGF receptor Flt-1, in blood vessels of tumour marginal zones and of peri-tumour areas. This is in contrast to the capillaries within normal Leydig cell clusters which demonstrate both Flt-1 and KDR. Ultrastructural destabilisation of the vascular wall, evident as a lack of basement membrane and of peri-endothelial cells was also present in nearly 85% of blood vessels of the peri-tumour areas. In contrast, approximately 89% of the blood vessels of the tumour centre region demonstrated a stabilised vascular wall including basement membrane and peri-endothelial cells. Local application of VEGF(165) to the normal testicular tissue induced significant ultrastructural destabilisation in the capillary walls which only expressed KDR. These results suggest an autocrine role of VEGF on endothelial cells of tumour blood vessels in a region-specific manner and implicate that VEGF interactions with KDR, in the absence of Flt-1, may be involved in vascular destabilisation. In addition, the finding that most (79%) of Leydig tumour blood vessels are stabilised may account for the low malignant potential of these tumours.
Journal Article↗
[Anatomy and blood supply of the penis and urethra].
The exact knowledge of the topographic anatomy of the urethra as well as the macro- and microcirculation of the penis [6] are the basics of reconstructive urethral surgery. Adherence to the fundamentals and principles of tissue transfer [5] are necessary to fascilitate conditions for successful treatment of the various disorders of the male urethra. Mutural description of the anatomy of the male urethra in conjunction with external male genitals is necessary because of developmental similarities as well as the close anatomical relationship. The arterial and venous blood supply of the urethra and the penis have to be taken into account if vascularized flaps from the penile skin or the prepuce are used in urethral reconstruction. The dual arterial and venous vascularity of the genital skin is of fundamental importance to a successful outcome of the operative treatment. The purpose of this article is, to summarize the relevant anatomical knowledge of reconstructive urethral surgery.
Adolescent↗
[Bulbo-bulbar and bulbo-prostatic anastomosis of the urethra].
Strictures of the bulbous and membranous urethra up to 2.5 cm in length and after visual urethrotomy should be managed with an one-stage perineal anastomotic repair. With description of the surgical techniques the results of 41 patients, treated between 1977 and 1996, are presented. 28 patients had bulbomembraneous strictures as result from urethral disruption at the time of pelvic fracture. In 13 cases with bulbar strictures, 11 had been caused iatrogenously and 2 by infection. A successful outcome was achieved in over 90% (37 patients), equivalent to a maximum uroflow over 15 ml/s, an empty bladder after voiding and a radiographic wide anastomosis. Only 4 patients (9.8%) after surgery required an urethrotomy; two of them are dilated frequently.
Adolescent↗
Elevated human chorionic gonadotropin concentrations in the testicular vein and in peripheral venous blood in seminoma patients. An analysis of various parameters.
OBJECTIVE: Human chorionic gonadotropin (HCG) elevations in the testicular vein (TV) are correlated with those in the cubital vein (CV). Their significance was tested regarding various prognostic parameters. METHOD: Within the framework of a large multicentre study to assess the prognosis of HCG-positive seminomas 726 eligible patients were recruited from 1986 to 1991. A total of 378 had elevated and 348 had normal HCG measured in the CV. In 144 patients samples were taken from the TV. Histological diagnosis of seminoma was confirmed by two reference pathologists. Three groups (group I: elevated HCG in CV and normal or elevated HCG in TV; group II: normal HCG in CV and elevated HCG in TV; group III: normal HCG in CV and normal or unknown HCG in TV) were compared in relation to the presence or absence of metastases, stage of the disease, size of the primary tumour, pT category, vascular invasion and lactate dehydrogenase. RESULTS: Of the TV serum samples, 85% were HCG-positive. Regression analysis revealed higher values in the TV compared to the CV according to the following equation: HCGTV = 520 + 1.12 x HCGCV, R = 0.766, with a mean variation of 14%. Patients in group I had significantly higher stages and larger primary tumours than patients with normal HCG in the CV, irrespective of the HCG values in the TV blood (groups II and III). Therefore, HCG is associated with tumour mass. No differences of statistical significance were found regarding T category, vascular invasion and lactate dehydrogenase. There were no differences between groups II and III. CONCLUSION: Only HCG values of the CV are associated with known adverse-prognostic factors of seminomas, such as metastases and size of the tumour. HCG in the TV adds no further information for the clinical assessment of patients with seminoma.
Austria↗
Endocrinological disturbances in germ cell tumour patients. Comparison of hormone levels and kinetics in peripheral and testicular vein blood.
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Germinoma↗
Carcinoma-in-situ in testes with germ cell tumour. Comparison of clinical parameters with histological findings in testicular tissue near to and distant from the tumour.
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Carcinoma in Situ↗
[Metastases of germ cell tumors to the ENT area--a rare differential diagnosis of lymph node metastases in unknown primary tumor].
BACKGROUND: Germ cell tumors of the testis usually metastasize to retroperitoneal lymph nodes, lungs, and liver. Other lymphatic or organ metastases especially in the head and neck are rare. CASE REPORTS: The cases of two men, ages 21 and 35, are presented. In both cases, the histologic examination of cervical lymph node specimen lead to the correct tumor diagnosis of testicular cancer. Multimodal urooncologic therapy led to long-lasting complete remissions in both cases. CONCLUSIONS: In young men between 20 and 35 years of age with cervical metastases of tumors of unknown primary site, germ cell tumors must be suspected. Histologic findings of non-squamous epithelial metastases (seminoma, embryonal carcinoma, chorionic carcinoma, teratoma, yolk sack tumor, and their combined forms) with or without retroperitoneal, mediastinal, or lung metastases; elevated tumor markers (human-chorionic gonadotropin, alpha-feto-protein, placental alkaline phosphatase, lactate dehydrogenase); and palpable intratesticular mass lead to the correct tumor diagnosis. Early detection of the disease is essential for successful therapy and long-term remission.
Adult↗
Tu-M2-PK in the blood of testicular and cubital veins in men with testicular cancer.
We wanted to verity whether M2-PK is a useful marker in testicular cancer. In a prospective study of 20 consecutive patients, blood was drawn from the testicular and the cubital vein before semicastration and later. For the detection of M2-PK we used the Assay of ScheboTech. In the testicular vein M2-PK was 11.2 U/ml. In the cubital vein it was 6.2 U/ml before semicastration, increasing in the following days. There were no significant differences between testicular and cubital vein blood, between the non-metastasized patients and the metastasized stages and between the patients with seminoma and non-seminomatous tumors. There is no profit in the diagnosis of testicular cancer using Tu-M2-PK.
Biomarkers, Tumor↗